Maxicare 2010 Family Brochure 4o1i3n

The Leader in Healthcare Services MAXICARE HEALTHCARE CORPORATION quality healthcare is deserved by every individual. MAXICARE, an industry leader with 22 years of solid healthcare expertise, has been a trusted name among top corporations and individuals.

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I. IN-PATIENT BENEFITS • Room and Board Accommodation • Use of Operating Room, Intensive Care Unit (ICU), Isolation Room (if prescribed by an attending accredited physician) and Recovery Rooms • Professional Fees of Attending Physicians, Surgeons, Anesthesiologist and Cardio-pulmonary clearance before surgery and cardiac monitoring during surgery • Standard nursing services • Medicines for in-patient use • Blood product transfusions and intravenous fluids, including blood screening and cross matching • X-ray, laboratory examinations, diagnostic tests and therapeutic procedures incidental to confinement • Dressings, conventional casts (plaster of Paris) and sutures • Anesthesia and its istration • Oxygen and its istration • Standard ission kit • Other items directly related in the medical management of the patient, as deemed medically necessary by the attending accredited physician II. OUT-PATIENT BENEFITS The following services shall be provided when medically necessary: • Consultations during regular clinic hours, except for medicines prescribed • Eye, ear, nose and throat (EENT) treatment prescribed by an accredited physician/specialist • Treatment of minor injuries such as lacerations, mild burns, sprains and the like • Dressing, conventional casts (plaster of Paris) and sutures • X-ray, laboratory examinations, routine, diagnostic and therapeutic procedures prescribed by an accredited physician/specialist, provided however that the cost of diagnostic and therapeutic procedures covered shall be limited to the amount set forth under pertinent sections below. o Routine procedures to be covered at 100% of actual cost and to be charged against MBL: 1. Blood Chemistries 2. Chest X-Ray 3. Complete Blood Count 4. Fecalysis 5. Urinalysis o Diagnostic procedures to be covered at 100% of actual cost and to be charged against MBL: 1. 24-Hour Electro Encephalogram Monitoring 2. Adrenocortical Function 3. Anti-Nuclear Antibody, C-Reactive Protein, Lupus Cell Exam 4. Arterial Blood Gas 5. Arthroscopic Procedures, Orthopedic Arthroscopy 6. Audiograms and Tympanograms 7. Bone Densitometry Scan (Dexascan) 8. Bone Mineral Density Studies 9. Cardiac Ambulatory Monitoring 10. Cardiac Stress Tests (Thallium and Dipyridamole Stress Tests) 11. Computed Tomography (CT) Scans 12. Diagnostic Angiogram: Cerebral, Coronary, Mesentric, Flourescein Angiography 13. Diagnostic Radiographs or X-rays i. Biliary Tract: Cholecystogram and Cholangiogram ii. Chest, Ribs, Sternum and Clavicle iii. Digestive Tract: Plain film of the abdomen, Barium Enema, Upper Gastro Intestinal (GI) Series, Small Bowel Series, Lower Gastro Intestinal Series iv. Face (including sinuses), Head and Neck v. Urinary Tract: Kidney Ureter Bladder (KUB), Pyelograms, Cystograms vi. X-ray of the extremities and pelvis vii. X-ray of the Spine (cervical, thoracic, lumbo-sacral)

14. Diagnostic Ultrasounds: i. 2D-Echo with Doppler ii. Abdomen iii. Duplex Scan iv. Digestive and Urinary Systems v. Ultrasound of the Lungs 15. Electro Encephalogram (EEG) 16. Electromyography & nerve conduction velocity studies 17. Endoscopic Procedures 18. Impedance Plethysmography 19. Lead Electrocardiogram 20. Magnetic Resonance Angiography (MRA) 21. Magnetic Resonance Imaging (MRI) 22. Microscopic Examinations 23. Myelogram 24. Nuclear Radioactive Isotope Scan 25. Pap’s Smear 26. Plasma Urinary Cortisol, Plasma Aldosterone 27. Polysomnograms (Sleep Recording) 28. Pulmonary Function tests 29. Radioisotope Scans and Function Studies: i. Cardiac ii. Gastrointestinal iii. Liver iv. Parathyroid, Bone, Pulmonary (Perfusion, Ventilation Lung Scans) v. Renal vi. Thyroid Scans vii. Total Body Scans 30. Radionuclide Ventriculography 31. Surface Electromyography (SEMG) 32. Thallium Scintigraphy 33. Treill Stress Test (TMST) • Therapeutic procedures shall be covered at 100% of actual cost and to be charged against MBL up to twelve (12) sessions per member per year o Dialysis o Intravenous Chemotherapy o Therapeutic Radiology 1. Brachytherapy 2. Cobalt 3. Linear Accelerator Therapy 4. Radioactive Cesium 5. Radioactive Iodine o Physical therapy / Occupational therapy (shared limit) excluding subspecialties such as cardiac rehabilitation, pulmonary rehabilitation and the like. (Therapy of one (1) body area shall be considered as one (1) session,) • Minor surgery not requiring confinement prescribed by an accredited physician/specialist • Eye laser therapy for retinal tear, retinal hole, retinal detachment & glaucoma prescribed by an accredited physician/specialist up to Php10,000 per eye per member per year • Cauterization of warts prescribed by an accredited physician/specialist up to Php1,000 per year, in any part of the body except genital warts and condyloma acuminata

• Sclerotherapy for varicose veins as prescribed by an accredited physician up to Php5,000 per leg per member per year to be availed through accredited vascular surgeons • Allergy testing / allergy screening and other related examinations prescribed by an accredited physician up to Php2,500 per member per year • Speech therapy (for stroke patients only) shall be covered as charged but on reimbursement basis up to Php10,000 per member per year. Consultations shall be part of the limit and treated as sessions for purposes of determining coverage • Tuberculin test up to Php600 per member per year. III. SALIENT FEATURES PLAN TYPE Platinum Plus Platinum Gold Silver

R&B Large Private Regular Private Regular Private Semi-Private

MBL Php 200,000 150,000 100,000 60,000

R&B – Room and Board Accommodation (room category) MBL – Maximum Benefit Limit (limit per illness per year) IV. PREVENTIVE CARE • ive and active vaccines for treatment of tetanus and animal bites shall be covered up to Php18,000 per member per year • Periodic monitoring of health problems • Health education and counseling on diets and exercise • Health habits & family planning counseling V. EMERGENCY CARE • Accredited Hospital o Doctor’s services

o Emergency Room fees o Medicines used for immediate relief and during treatment o Oxygen, intravenous fluids and blood products o Dressings, conventional casts (plaster of Paris) and sutures o X-rays, laboratory, diagnostic examinations and other medical services related to the emergency treatment of the patient • Non-Accredited Hospitals o Within the Philippines Maxicare shall reimburse 80% of the total hospital bills and 80% of the professional fees based on Maxicare’s rates up to Php 30,000 per case during the first 24 hours. o Areas without accredited hospitals within the Philippines Maxicare shall reimburse 100% of the total hospital bills and Professional fees based on Maxicare rates. o Outside the Philippines Maxicare shall reimburse 100% actual costs up to Php30,000 per case during the first 24 hours. • Ambulance Service Maxicare will cover road ambulance service for transfers from an accredited hospital to another accredited hospital up to MBL and Php2,500 per conduction if it is from a non-accredited Hospital to an accredited Hospital (on reimbursement basis). Note: it is very important that you call the Maxicare Hotline within 24 hours in order for Customer Care to arrange a transfer from the non-accredited hospital to the accredited hospital. • Initial treatment of animal bites shall be covered for the first twenty-four (24) hours from the time of bite subject to MBL.

VI. ADDITIONAL BENEFITS • Life coverage with Accidental Death & Dismemberment up to Php25,000 • Motor vehicular accidents shall be covered up to MBL. • Scoliosis (whether congenital, pre-existing or acquired) covered up to Php20,000 per member per year • Congenital illness, except physical therapy sessions and developmental disorders, shall be covered up to Php20,000 per member per year. Congenital hernia shall however be covered up to MBL. • Consultations for Chronic Dermatoses shall be covered up to MBL per member per year. • Additional Modalities and Procedures covered up to MBL whether done in in-patient or out-patient: 1. Cryosurgery 2. Gamma Knife Surgery 3. Hysterescopic Myoma Resection 4. Hysterescopically-guided Dilation & Curettage 5. Laparoscopy 6. Lithotripsy 7. Percutaneous Ultrasonic Nephrolithomy 8. Conventional Hemmorhoidectomy 9. Scalpel Hemmorhoidectomy • Other medically necessary modalities not mentioned above for which there are no comparable, conventional or traditional counterparts shall be covered up to Php 5,000 per procedure per member per year. • Transurethral Microwave Therapy of Prostate covered up to Php25,000 per member per year VII. ANNUAL CHECK-UP (ACU) Platinum Plus Plan: (Multi – Phasic B) – Overnight at MMC • CBC (Complete Blood Count) • Blood Chemistry (Fasting Blood Sugar, Potassium, Total Cholesterol HDL, LDL, VLDL Cholesterol, Triglycerides, Urea, Creatinine, SGOT, SGPT, Alkaline Phosphatase, Total Bilirubin, Total Protein, Albumin, Globulin, Calcium, Uric Acid) • Thyroid Function: TSH-IRMA • Hepatitis Screening: HBsAG, Anti-HBs • Routine Urinalysis • Routine Fecalysis • Cardiac Work-up (Upper Gastrointestinal series or Barium Enema, Ultrasound of Liver, Gallbladder & Pancreas, Proctosigmoidoscopy_ • Papsmear for female regardless of age • Prostate Ultrasound for male regardless of age • Consultations to a Gastroenterologist, Gynecologist/Urologist and Cardiologist Platinum Plan: Executive Out-patient • Physical Examination • Routine Urinalysis • Routine Fecalysis • Chest X-ray • CBC (Complete Blood Count) • Blood Chemistry (Fasting Blood Sugar, Potassium, Creatinine, SGOT/AST, Alkaline Phosphatase, Total Protein, Albumin, Calcium, uric Acid, BUN, Total Bilirubin, Sodium Chloride/CO2 and Cholesterol) • Ultrasound of Kidney • 12 Lead ECG • Treill Stress Test • Ultrasound of Liver, Gallbladder and Pancreas • Pap Smear (slides) for female regardless of age Gold Plan: Semi-Executive Out-patient • Physical Examination • Routine Urinalysis • Routine Fecalysis • Chest X-ray

• • • •

CBC (Complete Blood Count) Blood Chemistry (Fasting Blood Sugar, SGPT, Cholesterol, Creatinine, Uric Acid) 12 Lead ECG Pap Smear (slides) for female regardless of age

Silver Plan: Routine • Physical Examination • Routine Urinalysis • Routine Fecalysis • Chest X-ray • CBC (Complete Blood Count) • 12 Lead ECG (exclusive for 35 years old and above as an optional package) • Pap Smear (exclusive for 35 years old and above as an optional package) The ACU however, may only be availed within the contract period after and the member is at least six (6) months starting from the effectivity date. Member must notify Maxicare’s Customer Care Department (CCD) at least one (1) month prior to preferred schedule. Any request for rescheduling or change of venue must be in writing and shall be allowed only once provided request was forwarded to CCD at least one (1) week prior to the original ACU schedule. Otherwise, ACU entitlement shall be forfeited Note: Inclusive tests are subject to change based on hospital’s/clinic’s current ACU package.

VIII. DENTAL CARE (OPTIONAL) • • • • • • • • • • • •

Annual Oral/Dental Examinations & Consultation Emergency Dental Treatment Annual Oral Prophylaxis Simple Tooth Extractions Restorative and Prosthodontic Treatment Planning Permanent fillings up to 2 fillings per year Unlimited temporary fillings,as needed Desensitization of hypersensitive teeth – 2 per year Simple adjustment of dentures Recementation of loose crowns, inlays or onlays Dental nutrition and dietary counseling Dental Health Education

IX. VALUE ADDED FEATURES MAXICARE’S INTERNATIONAL EMERGENCY ASSIST PROGRAM Maxicare has partnered with International SOS, the world’s largest medical and emergency assistance company, to give you Maxicare International Assist Program. It gives you worldwide access to 24-hour expert advice and assistance - - whether it’s help you need to prepare you for your travels or emergency advice and medical care while abroad. Medical Assistance • • • • •

24-Hour Telephone Medical Advice Emergency Medical Evacuation Emergency Medical Repatriation Repatriation of Mortal Remains Hospital Referral, arrangement of ission and Guarantee of Medical Expenses

• Monitoring of Medical Condition • Delivery of Essential Medicine • Discounted Hospitalization Expenses in the United States The limit of indemnity for a member per event, per illness or condition per year is US$ 1,000,000. International SOS retains the absolute right to decide whether the member’s medical condition is sufficiently serious to warrant Emergency Medical Evacuation or Repatriation. If and when member’s condition does not merit an evacuation, repatriation afs per International SOS assessment and the member requests for such evacuation / repatriation, International SOS shall carry out the request, however, expenses shall be the member’s responsibility. All pre-existing conditions are waived under this coverage. Travel Assistance • • • •

Pre-trip Information Services Embassy / Legal / Interpreter Referrals Lost luggage and port Assistance Emergency Message Transmission or Document Delivery Assistance

*Any advice through the hotline is free. All third party costs shall be member’s responsibility. 24 hour Alarm Center: (+632) 687-8522

X. AVAILMENT PROCEDURES • Out-patient 1. To avail of consultations or treatment, go to any Maxicare Accredited Clinics/Hospitals or Maxicare Primary Care Centers (PCC). 2. Member goes to the POS terminal in the hospital/clinic (Billing/ER/itting section) or at the PCC.

3.

Hospital staff swipes the member’s swipe card. The Letter of Eligibility (LOE) will be given to the member with his Maxicare card.

Please note that the LOE is valid only on the same date that it was swiped. Availments made on different dates will need an LOE per date.

4. 5. 6. 7.

Member proceeds to the Medical Coordinator’s clinic and presents his LOE and Maxicare card for consultation. If referred to an accredited specialist, secure LOE and Referral Slip* from the Medical Coordinator/ PCC. Present Maxicare ID Card, LOE and Referral Slip to accredited specialist to avail of consultation.

If member is requested to take a laboratory test, secure the Laboratory Slip* from the Medical Coordinator/ PCC. 8. Proceed to the laboratory and present the laboratory slip with the LOE and avail of the test. 9. For follow-up consultations, follow steps 1-5 to secure LOE and referral slip/ laboratory slip from Maxicare Centers and/or Coordinator. Note: Referral Slips and Laboratory Slips* are necessary in order for the doctor to know that Maxicare is to be billed for the procedure. For queries and assistance, please call Maxicare Hotline at 582-1900. • In-patient

1. 2.

Secure an itting Order from a Maxicare Accredited Specialist.

Coordinate with the itting section and coordinator in the hospital for room reservation 3. If possible, call Maxicare at least 24 hours prior to ission for assistance in securing the doctor 4. Member goes to the itting Section in the hospital and presents his/her Maxicare swipe card and itting order from the Maxicare Coordinator/ Specialist to the itting staff. 5. Once the LOE is generated by the hospital staff, the member will be asked to sign on it. This will be attached to the other itting documents. 6. Proceed to the reserved room entitled or operating room (for operation)

7. 8. 9.

Maxicare will issue the Letter of Authority (LOA) upon receiving hospital’s advice on the member’s confinement. Member must file Philhealth on or before discharge. All uncoverable and excess charges must be settled by the member upon discharge.

Note: For queries and assistance, call Maxicare Hotline: 582-1900 • Emergency Care A life threatening or accidental injury or a sudden and unexpected onset of a condition which at the time of the occurrence reasonably appears to have the potential of causing immediate disability or death, or which requires the immediate alleviation of pain or discomfort. The Member must notify MAXICARE HEAD OFFICE, thru the Customer Care Department, WITHIN 24 HOURS so that proper assistance is promptly rendered. o Accredited Hospital 1. Go to the Emergency Room of nearest accredited hospital. 2. Avail of treatment at Emergency Room. 3. Present Maxicare ID Card to ER Staff. ER Personnel will facilitate swiping for the LOE. 4. File Philhealth before discharge. Note: Settle charges not covered by Maxicare at the Billing Section once the Discharge Order is issued by the attending doctor. o Non-Accredited Hospital

1.

Member may proceed to the Emergency Room of nearest hospital. 2. Avail treatment at the Emergency Room. 3. Call Maxicare within 24 hours to arrange transfer to an accredited hospital. 4. Settle all ER fees and secure Medical Certificate, Official Receipts, etc. 5. Forward all original documents to Maxicare for reimbursement within 30 days upon discharge.

XI. ENROLLMENT PROCESS AND GUIDELINES 1. Fill up the IFG application form completely. Indicate your Tax Identification Number (TIN) on the front page if applicable. 2. Initial submission of Medical Requirements is applicable to enrollees who are 50 years old and above, whether Principal or Dependent. The date of the conduction of these Medical Requirements should not exceed 6 months before the date of submission. Medical Requirements for 50 years old and above • 12 - lead ECG (Electrocardiogram) • Chest X-ray • FBS (Fasting Blood Sugar) • Total Cholesterol • HDL-C (High Density Lipoprotein) • LDL-C (Low Density Lipoprotein) Note: test results should not be more than 6 months from the date it was taken 3. Dependent’s plan must be the same plan as the Principal or one plan lower. 4. Forward the accomplished application form and medical requirements (if applicable) to the Officer for processing. 5. Once the application has been approved, the Statement of shall be sent to your billing address for settlement. Payments (cash or check) may be made at the Maxicare Head Office or at any Banco de Oro branches via bills payments. 6. Member will receive Maxicare ID card as proof of hip.

Who may be enrolled into the Maxicare Program and what are the requirements? • The age eligibility for principal and dependents is from 2 to 60 years of age. • Eligible dependents are as follows (in order): * For single enrollees: Mother, Father, then Siblings 21 years old and below, according to age. * For married enrollees: Spouse, then Children 21 years old and below, according to age. • Individual hip Requirements: 1. Application form 2. Medical requirements if already 50 years old 3. Photocopy of ACR (Alien Certificate of Residency) if nationality is foreign • Family hip Requirements Couples only: 1. Application form 2. Copy of marriage certificate 3. Medical requirements if already 50 years old (principal and dependent) 4. Photocopy of ACR (Alien Certificate of Residency) if nationality is foreign With child dependent 1. Application form 2. Copy of birth certificate (each child) 3. Medical requirements if already 50 years old (principal and dependent) 4. Photocopy of ACR (Alien Certificate of Residency) if nationality is foreign Note: Maxicare may request for additional requirements when deemed necessary • HIERARCHY OF ENROLLMENT:  Unless there is a valid reason for the non-enrollment of certain dependents (i.e. currently enrolled in another HMO, abroad, separated, deceased, etc.), applicants should enroll their dependents in the priority specified above. • Sufficient documentation shall be requested by Maxicare from the applicant to validate the non-eligibility of the dependent (i.e. photocopy of HMO card, certificate of employment from company abroad, death certificate, etc.) REQUIREMENTS FOR ALIEN RESIDENTS/ FOREIGN NATIONALS: 1. Photocopy of ACR (Alien Certificate of Residency) ID 2. Medical Requirements for enrollees 50 years old and above (if applicable) 3. Certificate of employment (if applicable) XII. DREADED DISEASE / CONDITION Any condition that is considered to be chronic, progressive, life-threatening and which may entail lifelong therapy. This refers also to conditions where complete cure cannot be ensured. COVERAGE FOR DREADED AND NON-DREADED CONDITONS 1st year of hip: • Dreaded and Non-dreaded covered subject to below limits: Plan Type Platinum Plus Platinum Gold Silver

Per illness per member per year Php 20,000 15,000 10,000 5,000

Subsequent years of hip: • Dreaded conditions not considered acquired are covered subject to below limits:

Plan Type Platinum Plus Platinum Gold Silver • •

Per illness per member per year Php 20,000 15,000 10,000 5,000

Non-dreaded conditions shall be covered up to MBL Acquired dreaded conditions shall be covered up to MBL

Such dreaded conditions are as follows, but not limited to: 1. All cancers (malignant masses) including carcinoma in situ and related conditions 2. Blood Dyscrasias (Leukemia, Idiopathic Thrombocytopenic Purpura, etc) 3. Central Nervous System Infections (Poliomyelitis/Meningitis/Encephalitis) 4. Cerebrovascular Accident (Stroke, Cerebral, Cerebellar and all Intracranial Hemorrhage) and related conditions 5. Chronic Cardiovascular Diseases (Complicated Hypertension and related conditions, Aortic Dissection, Abdominal Aortic Aneurysm, etc.) 6. Chronic Endocrine Disorders and its complications (Dyslipidemia, Impaired Fasting Glucose, Impaired Glucose Tolerance, Obesity, Diabetes Mellitus, Hormonal Dysfunctions, etc.) excluding surgical treatment/procedures for obesity-exclusion 7. Chronic Gastrointestinal Diseases (ex. Irritable Bowel Syndrome, Crohn’s disease) 8. Chronic Genito-urinary Disorders 9. Chronic Kidney Disease/Failure 10. Chronic Liver Parenchymal Diseases (Liver Cirrhosis, Chronic hepatitis) 11. Chronic Pulmonary Diseases except asthma (COPD, emphysema, and other chronic lung disease) 12. Collagen Vascular/Connective Tissue/Immunologic Disorders 13. Complications of immuno-compromised state except HIV/AIDS 14. Injuries incurred prior to and up to one year from effective date and its subsequent complications 15. Systemic Lupus Erythematosus including Lupus Nephritis 16. Thyroid conditions (Hypothyroidism, Hyperthyroidism) except Thyroid masses 17. Valvular Heart Diseases 18. Any illness other than above which would require Intensive Care Unit Confinement 19. All complications resulting from above list of conditions

Such non-dreaded conditions are as follows, but not limited to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

All tumors (benign masses) Anal Fistulae Arthritis Bronchial Asthma Buegher’s Disease Cataract and Glaucoma Cholecystitis, Cholelithiasis, Cholecystolithiasis and Choledocholithiasis Ear-Nose-Throat conditions requiring surgery (except cancers which are considered dreaded conditions) Endometrioses/Dysfunctional Uterine Bleeding (except if caused by uterine malignancies) Gastric or Duodenal Ulcers Hallux valgus Hemorrhoids Hernias (Congenital Hernia will have coverage as listed in the Congenital Clause) Migraine Muscular Dystrophies (Duchenne, Becker, limb girdle, facioscapulohumeral, myotonic, oculopharyngeal, distal, and Emery-Dreifuss) Ovarian cysts (except Ovarian Malignancies) Peripheral Nervous System Lesions (except Multiple Sclerosis and Guillan Barre Syndrome) Tuberculosis (Pulmonary or Extrapulmonary including Pott’s disease) Uncomplicated Hypertension Urinary Tract Stones/Calculi All complications resulting from above list of conditions

XIII. EXCLUSIONS AND LIMITATIONS Notwithstanding any provisions to the contrary, the following shall not be covered except otherwise specified in Agreement: • Services obtained for non-emergency conditions from Physicians and Hospitals in any of the following circumstances: o non-accredited physicians in non-accredited hospitals or clinics; o non-accredited physicians in accredited hospitals or clinics; o accredited physicians in non-accredited hospitals or other non accredited healthcare facility. • Additional hospital charges and physician’s professional fees resulting from: o room-upgrading beyond member’s allowable time during emergency care; o obtaining a room accommodation higher than the member’s room and board Accommodation. o extension of hospital stay despite release of discharge order from member’s attending physician; o additional personal comfort items such as additional telephone and TV, etc., not ordinarily included in the member’s room and board Accommodation. • Custodial, domiciliary, convalescent and intermediate care. • Long-term rehabilitation and psychiatric care and/or psychological illnesses and conditions including neurotic and psychotic behavior disorders; anxiety disorders. • Treatment for injury and its complications resulting from self-inflicted injuries including infections as a result of tattoos, piercing of the ear or in any body part, whether self-inflicted or done by a third party or attempted suicide or selfdestruction, whether sane or insane. • Developmental disorders including functional disorders of the mind, such as but not limited to Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Bipolar Disorders, Central Auditory Processing Disorder (CAPD), Cerebral Palsy, Down Syndrome, Neural Tube Defects, and Mental Retardation. • Treatment of any injury received when there is negligence, unauthorized use of prohibited or regulated drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime whether consummated or not, violation of a law or ordinance or unnecessary exposure to imminent danger, knowingly or unknowingly or hazard to health, by the member. Maxicare may, in its discretion, rely on Police and Doctor’s report in evaluating such claim. • Aesthetic, cosmetic and reconstructive surgery or any consultation or treatment for any beautification purposes except if necessary to treat a functional defect due to accidental injury within the initial confinement. • Oral surgery following accidental injury to teeth for purposes of beautification. Dental examinations, extractions, fillings, other dental treatment and their complications to the extent that are medically necessary for repair or alleviation of damage to the member caused solely by an accident. Medical care resulting from any dental related conditions. • Maternity care and all other conditions, including pre and post natal consultations, related to and/or resulting from pregnancy and/or delivery which affect the conditions of the principal member and the unborn child. • Circumcision (except for treatment of urological conditions), sex transformation, diagnosis, treatment and procedures related to fertility or infertility, artificial insemination, sterilization or reversal of such procedures and their complications. • Experimental medical procedures. • Acupuncture and chirotheraphy and other forms of rehabilitations therapies or any complications arising from its application. • All expenses incurred in the process of organ donation and transplantation if the member is the donor of such donation or transplantation. • Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance, government licensing, health permit and other similar purposes. • Purchase or lease of durable medical equipment, oxygen dispensing equipment, and oxygen, except during in-patient care.

• Corrective appliances, artificial aids, prosthetic appliances such as but not limited to artificial limbs, hearing aids, intraocular lens, eyeglasses, lenses, braces, crutches, pace maker, pins, screws, plates, wires, balloons, valves, knee-tibial insert for total knee arthroplasty, orthopedic internal fixator/fixation systems, orthopedic external fixator/fixation systems, bone screws and plates, vascular grafts/stents, intravascular catheters, myringotomy tube. • Take-home medicine and outpatient medicine except o Intravenous medicine o Oral chemotherapy medicine o Medicine istered during an emergency treatment • Congenital diseases, abnormalities and their complications (except for hernias) affecting functions of individuals. • All physical deformities prior to enrollment. • Treatment of injuries/illnesses caused directly or indirectly by engaging in any hazardous or sport activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing, rock climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and bungee jumping, except for activities under company-sponsored sports activities. • Injuries resulting from direct participation in riots, strikes, and other civil disturbances. • Treatment of injuries or illnesses resulting from war and any combat-related activities while in military service. • Sexually transmitted diseases, genital warts, AIDS and AIDS related diseases. • Valvular heart disease (congenital and/or acquired) including Cardiomyopathies, Chronic Glomerulonephritis, previous craniotomy sequelae/hearing impairment/ Neurologic disease and Spinal Stenosis (if pre-existing)/Poliomyelitis/Slipped disc (if pre-existing) and Guillain-Barre Syndrome, Diabetes and its complications (if pre-existing), Complicated Hypertension (e.g. those with history of stroke, myocardial ischemia or infarction and poor kidney function), and all malignant tumors (if pre-existing). • Treatment for Chronic Dermatoses, except Scabies. • Infectious diseases (according to the local epidemiologic patterns) that may arise in times of an epidemic or pandemic (i.e. Avian Flu, Meningococcemia, etc.) as declared by the Department of Health, World Health Organization or any recognized health organization. • Hepatitis B and screening and vaccines for all types of Hepatitis. • Animal bite/scratch/lick or snake bite including its complications. • Benefits covered by Philhealth, Employee’s Compensation Commission Benefits (ECC) and all other government funded healthcare entitlements as provided for by law. • Laser procedures/treatments. • Speech therapy for developmental and congenital diseases. • Weight reduction programs, surgical operation or procedure for treatment of obesity, including gastric stapling or balloon procedures and liposuction. • Routine, diagnostic, therapeutic and other procedures of the same or similar nature not otherwise specified in this Agreement • Cost of vaccines and immunization including its istration. • Cost of medico-legal cases. • All screening tests if patient is o asymptomatic, no clinical signs and symptoms; o no previous history of the disease for which the test is requested for; and o personal request of the member which may fall under the above reasons. • Treatment of work-related injuries of high-risk occupations such as but not limited to construction workers, miners, loggers and drillers. • Cost of the medical services and professional fees in excess of the MBL. • All cases of assault whether provoked or unprovoked, whether initiated by the member or by a known or unknown third party. • Open heart surgeries, angioplasties, valvuloplasties, permanent pacemaker, balloon valvuloplasties, percutaneous intraaortic balloon counter pulsation and balloon atrial septostomy. • Home service. • Additional modalities and procedures not specified in this Agreement, in excess of Php 5,000. • Multiple sclerosis, epilepsy and seizures. • Degenerative diseases such as Alzheimer’s disease, Parkinson’s disease, Amyotrophic lateral sclerosis and others.

OTHER PROVISIONS: CUT OFF DATES For Individual and Family PAYMENT RECEIVED or Official Receipt dates

EFFECTIVE DATE

11th to 25th of the month

1st of the following month

26th to 30/31st of the month

16th of the next month

1st to the 10th of the month

16th of the current month

LAPSATION If a member fails to pay a hip fee on its due date, his or her hip shall be considered lapsed effective the day after the due date. A member whose hip has lapsed will not be entitled to any Benefit during the period that his hip is on a lapsed status, except in connection with illness or injury that supervened prior to such lapsation and for which the member had at that time made the necessary claim for the benefits under this Agreement.

REINSTATEMENT A member whose coverage has lapsed for failure to pay the hip fee on the due date may apply to reinstate his or her coverage within forty-five (45) calendar days from the date it is considered lapsed by (a) submitting a written request for reinstatement; (b) paying the hip fee due with arrears, including five hundred pesos (Php500) per member; (c) for modes of payment other than annual, paying in advance the hip fee due for the next period, provided however that there shall be no coverage of any benefit to the reinstated member within 30 calendar days from the effective date of reinstatement. If the hip fees due including five hundred pesos (Php500) remain unpaid within forty-five (45) days from the date it is considered lapsed, Maxicare reserves the right to suspend all services under this Agreement until full payment of all fees have been paid and settled. After the forty-five (45) days of non-payment of hip fees, Maxicare reserves the right to disapprove reinstatement and will require the member to re-apply. ***May change without prior notice***

2010 INDIVIDUAL HIP FEES Platinum Plus Age Group Annual

Platinum

Php 200,000

Php 150,000

Large Private

Regular Private

Semi-Annual

Quarterly

Annual

Semi-Annual

Quarterly

2-5

Php 36,604

Php 19,766

Php 10,249

Php 21,272

Php 11,487

Php 5,956

6 - 10

30,541

16,492

8.551

17,372

9,381

4,864

11 - 15

25,721

13,890

7,202

14,304

7,724

4,005

16 - 20

25,015

13,508

7,004

13,337

7,202

3,734

21 - 25

24,891

13,441

6,969

13,841

7,474

3,876

26 - 30

25,721

13,890

7,202

15,130

8,170

4,236

31 - 35

30,199

16,307

8,456

17,627

9,519

4,936

36 - 40

37,159

20,066

10,404

22,695

12,255

6,355

41 - 45

46,349

25,028

12,978

30,260

16,341

8,473

46 - 50

54,609

29,489

15,290

40,258

21,739

11,272

51 - 55

61,210

33,053

17,139

48,701

26,299

13,636

56 - 60

67,262

36,322

18,833

54,930

29,662

15,381

75,242

40,631

21,068

61,978

33,468

17,354

61 - 65*

Age Group 2-5 6 - 10 11 - 15 16 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65*

Annual Php 17,372 13,600 11,191 10,709 10,462 12,272 14,800 19,423 24,870 29,812 34,648 40,398 43,962

Gold Php 100,000 Regular Private Semi-Annual Php 9,381 7,344 6,043 5,783 5,650 6,627 7,992 10,488 13,430 16,099 18,710 21,815 23,739

Quarterly Php 4,864 3,808 3,133 2,998 2,929 3,436 4,144 5,438 6,963 8,347 9,701 11,311 12,309

Annual Php 12,866 10,720 9,073 8,630 8,630 9,818 10,575 12,877 19,305 23,110 25,684 28,534 29,756

Note: 1) *(61-65 age group) For renewing only 2) Exclusive of Dental Benefit

Silver Php 60,000 Semi-Private Semi-Annual Php 6,948 5,789 4,899 4,660 4,660 5,302 5,711 6,954 10,425 12,479 13,870 15,409 16,068

Quarterly Php 3,603 3,002 2,540 2,416 2,416 2,749 2,961 3,606 5,405 6,471 7,192 7,990 8,332

3) 4)

20% of hip fees at net of VAT is subject to 12% VAT. Additional VAT that may be imposed at the time of transaction is to be shouldered by the member Rates are effective January 1, 2010 and valid until December 31, 2010

2010 FAMILY HIP FEES

Age Group Annual

Platinum Plus

Platinum

Php 200,000

Php 150,000

Large Private Semi-Annual

Quarterly

Annual

Regular Private Semi-Annual

Quarterly

2-5

Php 30,505

Php 16,473

Php 8,541

Php 19,480

Php 10,519

Php 5,454

6 - 10

25,534

13,788

7,150

15,974

8,626

4,473

11 - 15

22,648

12,230

6,341

13,270

7,166

3,716

16 - 20

20,939

11,307

5,863

12,283

6,633

3,439

21 - 25

21,114

11,402

5,912

13,014

7,028

3,644

26 - 30

21,963

11,860

6,150

14,170

7,652

3,968

31 - 35

24,429

13,192

6,840

16,714

9,025

4,680

36 - 40

27,437

14,816

7,682

20,692

11,174

5,794

41 - 45

34,593

18,680

9,686

26,392

14,251

7,390

46 - 50

45,339

24,483

12,695

34,727

18,752

9,723

51 - 55 56 - 60 61 - 65*

52,744 60,131 67,952

28,482 32,471 36,694

14,768 16,837 19,027

42,000 49,131 55,617

22,680 26,530 30,033

11,760 13,757 15,573

Age Group Annual

Gold

Silver

Php 100,000

Php 60,000

Regular Private Semi-Annual

Quarterly

Annual

2-5

Php 14,341

Php 7,744

Php 4,016

Php 11,278

Semi-Private Semi-Annual

Quarterly

Php 6,090

Php 3,158

6 – 10

11,561

6,243

3,237

9,188

4,961

2,573

11 - 15

9,534

5,149

2,670

7,886

4,258

2,208

16 - 20

8,518

4,600

2,385

7,494

4,047

2,098

21 - 25

8,398

4,535

2,351

7,469

4,033

2,091

26 - 30

9,884

5,337

2,768

8,285

4,474

2,320

31 - 35

11,539

6,231

3,231

8,975

4,847

2,513

36 - 40

14,621

7,896

4,094

10,689

5,772

2,993

41 - 45

18,219

9,838

5,101

15,396

8,314

4,311

46 - 50

23,203

12,530

6,497

19,183

10,359

5,371

51 - 55

27,073

14,619

7,580

21,410

11,561

5,995

56 - 60

31,340

16,923

8,775

23,776

12,839

6,657

34,492

18,626

9,658

24,947

13,471

6,985

61 - 65*

Note: 1) * (61-65 age group) For renewing only 2) Exclusive of Dental Benefit 3) 20% of hip fees at net of VAT is subject to 12% VAT. Additional VAT that may be imposed at the time of transaction is to be shouldered by the member

4)

Rates are effective January 1, 2010 and valid until December 31, 2010

MAXICARE PRIMARY CARE CENTERS were put together with your convenience in mind. These are well- appointed to give the cardholders access to quality health care close enough to where they work or live. Each center has its staff of Customer Service Associates, Primary Care Physicians who are consultants specializing in Internal Medicine & Pediatrics and additional services like laboratory and ECG examinations (available at Filomena Bldg.). Because our centers are located close to major hospitals, our Customer Service Associates are able to facilitate easy access to quality diagnostics, specialist consultation and hospitalization when you need it. MAXICARE MEDICAL CLINICS OUTPATIENT G/F Filomena Building Amorsolo cor. Dela Rosa Sts., Legaspi Village, Makati City Tel. Nos: 893-4858 or 3898 MAKATI MEDICAL CENTER INPATIENT Room 131, New Wing #2 Amorsolo Street, Makati City Tel. Nos: 893-6064 | 893-9820 | 8888-999 loc 7265 & 7182 The NEW MEDICAL CITY Room MGR04, Ground Floor MATI Bldg. The Medical City Ortigas Avenue, Pasig City Tel. Nos. 636-2829 | 706-1526 635-6789 local 3006 & 5073

DE LOS SANTOS – STI MEGACLINIC 5/F SM Megamall Bldg. A Tel. No.: 632-7624 | 637-9661 local 108 MY HEALTH CLINIC- ALABANG 2L Style Boulevard, Festival Supermall Filinvest Corporate City, Alabang, Muntinlupa Tel. No.: 850-4855 CUSTOMER CARE CENTERS BACOLOD Rm. 215 North Point Building B.S. Aquino Drive, Bacolod City Tel. Nos: (034) 433-3044 | (034) 434-9230 CAGAYAN DE ORO 2/F Unit 215, De Leon Bldg. Yacapin St. Cor Velez St., Cagayan De Oro (08822) 71-47-25 | 71-47-26

ST. LUKE’S MEDICAL CENTER Room 1501 North Tower, Cathedral Heights, E. Rodriguez, Quezon City Tel. Nos: 723-5329 | 723-0101 loc 5151

DAVAO 2nd Floor Room 17 Jocar Complex C. de Guzman Street, Davao City (082) 227-2941 | 300-5553

DE LOS SANTOS MEDICAL CENTER Unit 302 De los Santos Bldg., De los Santos Medical Center, Quezon City Tel. Nos. 723-0041 to 54 Loc. 302 | 416-6144 | 416-6150

GENERAL SANTOS General Santos Doctors’ Hospital Engineering Office Ground Floor near 1B Station National Highway, General Santos City Tel. Nos: (083) 553-3963

CEBU Unit 308-309 3/F Dr. Jose Cecilio Borromeo Bldg., Kamuning St., Capitol Site, Cebu City (Across ER unit of Cebu Doctors Hospital) (032) 253-3082 | (032) 254-3980

ILOILO 2nd Floor, M22 AJL Annex Bldg. cor. Ibarra & General Luna Sts., Iloilo City Tel. No: (033) 337-1051

*For Providers’ Directory, please refer to List of Accredited Hospitals & Clinics at www.maxicare.com.ph

Your Easy Guide to Maxicare’s SMS Inquiry Service (0918-889-MAXI) 1)

To request list of accredited providers per area a) Hospital Key in: prov <space> hos <space> location Examples: prov hos makati prov hos bacolod b) Clinic Key in: prov <space> clinic <space> location Examples: prov clinic makati prov clinic ortigas

2)

To request list of accredited doctors per specialization per hospital Key in: doc <space> hospital name <slash> specialization Examples: doc makati med/gastro doc riverside/cardio

3)

To request doctor’s schedule and number per hospital Key in: sked <space> hospital name <slash> doctor’s surname Key words for each day: mon, tue, wed, thu, fri, sat, sun Examples: skedmon medical city/flandes skedsat makati med/genuino

Domestic: 908-6900 International Assist Hotline: (02) 687-8522 Customer Care Center: 582-1900 Toll Free No. for Provincial Inquiries (PLDT Line): 1-800-10-582-1900 SMS Inquiry: 0918-889-MAXI www.maxicare.com.ph